The undersigned enters into this Agreement with
______________________________________ ("Producer").
I have been informed and understand that Producer is producing
a videotape program and that my name, likeness, image, voice,
appearance and/or performance is being recorded and made a
part of that production ("Product").
1. I grant Producer and its designees the right
to use my name, likeness, image, voice, appearance, and performance
as embodied in the Product whether recorded on or transferred
to videotape, film, slides, photographs, audio tapes, or other
media, now known or later developed. This grant includes without
limitation the right to edit, mix or duplicate and to use
or re-use the Product in whole or part as Producer may elect.
Producer or its designee shall have complete ownership of
the Product in which I appear, including copyright interests,
and I acknowledge that I have no interest or ownership in
the Product or its copyright.
2. I also grant Producer and its designees the
right to broadcast, exhibit, market, sell and otherwise distribute
the Product, either in whole or in parts, and either alone
or with other products, for commercial or non-commercial television
or theater, closed-circuit exhibition, home video distribution
or any other purpose that Producer or its designees in their
sole discretion may determine. This grant includes the right
to use the Product for promoting or publicizing any of the
uses.
3. I confirm that I have the right to enter
into this Agreement, that I am not restricted by any commitments
to their parties, and that Producer has no financial commitment
or obligations to me as a result of this Agreement. I hereby
give all clearances, copyright and otherwise, for use of my
name likeness, image, voice, appearance and performance embodied
in the Product. I expressly release and indemnify Producer
and its officers, employees, agents and designees from any
and all claims known and unknown arising out of or in any
way connected with the above granted uses and representations.
The rights granted Producer herein are perpetual and worldwide.
4. In consideration of all the above, I hereby
acknowledge receipt of reasonable and fair consideration from
the Producer.
I have read the foregoing and understand its
terms and stipulations and agree to all of them:
Model's Name (Please Print) ___________________________________
Signature of Model ___________________________________________
Date_______________________
(If the person signing is under age 18, a parent
or legal guardian must sign below.)
I hereby certify that I am the parent or legal
guardian of the model named above and I give my consent without
reservation to the foregoing on behalf of him or her.
Signature of Parent or Guardian ________________________________
Date __________________________
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